{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T19:28:28Z","timestamp":1793042908804,"version":"4.5.0"},"reference-count":58,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009827","name":"Alexandria University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009827","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Oral Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Radiation-induced oral mucositis (RIOM) is a common and debilitating complication of radiotherapy in oral cancer patients, significantly impairing quality of life and potentially interrupting treatment. This study evaluated the therapeutic efficacy of N-acetylcysteine (NAC) nano-spray in managing RIOM, with particular emphasis on mucositis severity, quality of life, and serum gastrin-17 levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      In this randomized clinical study, 40 oral cancer patients undergoing radiotherapy were allocated in a 1:1 ratio to receive either NAC nano-spray (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920) or conventional therapy (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920) for six weeks. Mucositis severity was assessed using the World Health Organization (WHO) Oral Mucositis Severity Scale, and quality of life was evaluated using the Oral Health Impact Profile (OHIP-14). Serum gastrin-17 levels were measured before and after treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients treated with NAC nano-spray demonstrated a significant reduction in WHO mucositis grades and significantly improved OHIP-14 scores compared with the control group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Additionally, a significant increase in serum gastrin-17 levels was observed in the NAC group relative to conventional therapy (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). These effects were evident during radiotherapy and at the end of treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>N-acetylcysteine nano-spray appears to be an effective therapeutic option for the management of RIOM, reducing mucositis severity and improving quality of life in oral cancer patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>The trial was registered at Clinical Trials .gov on 24\/7\/2025, registration number: (NCT07082621).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12903-026-07959-7","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T13:13:26Z","timestamp":1774012406000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["N-acetylcysteine nano-spray versus conventional treatment in the management of radiotherapy-induced oral mucositis in oral cancer patients: a randomized clinical trial"],"prefix":"10.1186","volume":"26","author":[{"given":"Alaa","family":"Essam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahira El","family":"Domiaty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nahed","family":"Attia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hala","family":"Helal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Meheissen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"7959_CR1","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1002\/cncr.21622","volume":"106","author":"M Vera-Llonch","year":"2006","unstructured":"Vera-Llonch M, Oster G, Hagiwara MSS. Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer. 2006;106:329\u201336.","journal-title":"Cancer"},{"key":"7959_CR2","doi-asserted-by":"crossref","unstructured":"Liu S, Zhao Q, Zheng Z, Liu Z, Meng L, Dong L et al. Status of treatment and prophylaxis for radiation-induced oral mucositis in patients with head and neck Cancer. Front Oncol. 2021 Mar 18 ;11:642575. Available from: https:\/\/www.frontiersin.org. Cited 2025 May 22.","DOI":"10.3389\/fonc.2021.642575"},{"issue":"6 suppl 3","key":"7959_CR3","first-page":"3","volume":"2","author":"ST S","year":"2004","unstructured":"ST S. Oral mucositis in cancer therapy. J Support Oncol. 2004;2(6 suppl 3):3\u20138.","journal-title":"J Support Oncol"},{"issue":"suppl 1","key":"7959_CR4","doi-asserted-by":"publisher","first-page":"s1","DOI":"10.6004\/jnccn.2008.2001","volume":"6","author":"W Bensinger","year":"2008","unstructured":"Bensinger W, Schubert M, Ang KK, Brizel D, Brown E, Eilers JG, et al. NCCN task force report. Prevention and management of mucositis in cancer care. J Natl Compr Canc Netw. 2008;6(suppl 1):s1\u201321.","journal-title":"J Natl Compr Canc Netw"},{"key":"7959_CR5","doi-asserted-by":"crossref","unstructured":"Chang JE, Min SW, Kim CS, Han SH, Kwon YS, Hwang JY. L\u2019effet d\u2019une prophylaxie de chlorhydrate de benzydamine sur les maux de gorge et l\u2019enrouement postop\u00e9ratoires apr\u00e8s une intubation trach\u00e9ale \u00e0 l\u2019aide d\u2019une sonde endobronchique \u00e0 double lumi\u00e8re: une \u00e9tude randomis\u00e9e contr\u00f4l\u00e9e. Canadian Journal of Anesthesia. 2015 Oct 10;62(10):1097\u2013103. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/26149601\/. Cited 2025 May 22.","DOI":"10.1007\/s12630-015-0432-x"},{"key":"7959_CR6","doi-asserted-by":"crossref","unstructured":"Ferreira AS, Macedo C, Silva AM, Delerue-Matos C, Costa P, Rodrigues F. Natural products for the prevention and treatment of oral mucositis\u2014a review. International Journal of Molecular Sciences. 2022, Vol 23, Page 4385. 2022 Apr 15 ;23(8):4385. Available from: https:\/\/www.mdpi.com\/1422-0067\/23\/8\/4385\/htm. Cited 2025 May 22.","DOI":"10.3390\/ijms23084385"},{"key":"7959_CR7","doi-asserted-by":"publisher","first-page":"87","DOI":"10.3390\/dj8030087","volume":"8","author":"M Cronshaw","year":"2020","unstructured":"Cronshaw M, Parker S, Anagnostaki E, Mylona V, Lynch E, Grootveld M. Photobiomodulation and oral mucositis: a systematic review. Dent J. 2020;8:87.","journal-title":"Dent J"},{"key":"7959_CR8","first-page":"266","volume":"13","author":"Y Aisa","year":"2005","unstructured":"Aisa Y, Mori T, Kudo M, Yashima T, Kondo S, Yokoyama A, et al. Oral cryotherapy for the prevention of high-dose melphalan-induced stomatitis in allogeneic hematopoietic stem cell transplant recipients. Support Care Cancer. 2005;13:266\u20139.","journal-title":"Support Care Cancer"},{"key":"7959_CR9","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/j.lfs.2016.03.003","volume":"151","author":"I Elbini Dhouib","year":"2016","unstructured":"Elbini Dhouib I, Jallouli M, Annabi A, Gharbi N, Elfazaa SLM. A minireview on N-acetylcysteine: an old drug with new approaches. Life Sci. 2016;151:359\u201363.","journal-title":"Life Sci"},{"key":"7959_CR10","first-page":"52","volume":"547","author":"I Dobrzynska","year":"2000","unstructured":"Dobrzynska I, Skrzydlewska E, Kasacka IF. Protective effect of N-acetylcysteine on rat liver cell membrane during methanol intoxication. Protective effect of N-acetylcysteine on rat liver cell membrane during methanol intoxication. Pharm Pharmacol. 2000;547:52\u20133.","journal-title":"Pharm Pharmacol"},{"issue":"1","key":"7959_CR11","first-page":"141","volume":"12","author":"N Vahdati Mashhadian","year":"2013","unstructured":"Vahdati Mashhadian N, Jafari MR, Sharghic NS. The antioxidant action of N-acetylcysteine: its reaction with hydrogen peroxide, hydroxyl radical, superoxide, and hypochlorous acid. Pharm Res. 2013;12(1):141\u20136.","journal-title":"Pharm Res"},{"key":"7959_CR12","doi-asserted-by":"crossref","unstructured":"Li YQ, Zhang ZX, Xu YJ, Ni W, Chen SX, Yang Z et al. N-Acetyl-L-cysteine and pyrrolidine dithiocarbamate inhibited nuclear factor-\u03baB activation in alveolar macrophages by different mechanisms. Acta Pharmacol Sin. 2006 Mar;27(3):339\u201346. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/16490171\/. Cited 2025 May 22.","DOI":"10.1111\/j.1745-7254.2006.00264.x"},{"key":"7959_CR13","doi-asserted-by":"publisher","unstructured":"Maria OM, Eliopoulos N, Muzana T. Radiation-Induced Oral Mucositis. Front Oncol. 2017;7:89. https:\/\/doi.org\/10.3389\/fonc.2017.00089.","DOI":"10.3389\/fonc.2017.00089"},{"key":"7959_CR14","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.cden.2007.10.002","volume":"52","author":"RV Lalla","year":"2008","unstructured":"Lalla RV, Sonis, ST P DE. Management of oral mucositis in patients who have cancer. Dent Clin North Am. 2008;52:61\u201377.","journal-title":"Dent Clin North Am"},{"key":"7959_CR15","doi-asserted-by":"publisher","first-page":"5523","DOI":"10.1200\/jco.2006.24.18_suppl.5523","volume":"24","author":"MS Chambers","year":"2006","unstructured":"Chambers MS, Welsh DV, Scrimger RA, Zehn W, Epstein JB, Troha J. RK-0202 for radiation-induced oral mucositis. J Clin Oncol. 2006;24:5523.","journal-title":"J Clin Oncol"},{"key":"7959_CR16","doi-asserted-by":"crossref","unstructured":"Al ST. et. N-acetylcysteine rinse for thick secretion and mucositis of head and neck chemoradiotherapy (Alliance MC13C2): a double-blind randomized clinical trial. Mayo Clin Proc. 2019;94:1814\u201324.","DOI":"10.1016\/j.mayocp.2019.03.031"},{"key":"7959_CR17","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1002\/jbt.20240","volume":"22","author":"T Ahmed","year":"2008","unstructured":"Ahmed T, Tripathi AK, Ahmed RS, Das SSSG, Pathak R, et al. Endosulfan-induced apoptosis and glutathione depletion in human peripheral blood mononuclear cells: attenuation by N-acetylcysteine. Biochem Mol Toxicol. Biochem Mol Toxicol. 2008;22:299\u2013304.","journal-title":"Biochem Mol Toxicol"},{"key":"7959_CR18","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/1476-5926-11-4","volume":"11","author":"NA Kretzmann","year":"2012","unstructured":"Kretzmann NA, Chiela E, Matte U, Marroni NM. N-acetylcysteine improves antitumoural response of interferon alpha by NF-kB downregulation in liver cancer cells. Comp Hepatol. 2012;11:4.","journal-title":"Comp Hepatol"},{"issue":"7","key":"7959_CR19","first-page":"10031","volume":"10","author":"B Ayfer","year":"2017","unstructured":"Ayfer B, Ahmet \u00d6\u015e, G\u00fclden ZO, Serap APT. Protective effect of N-Acetyl-L-Cysteine (NAC) on endosulfan-induced liver and kidney toxicity in rats. Clin Exp Med. 2017;10(7):10031\u20139.","journal-title":"Clin Exp Med"},{"key":"7959_CR20","doi-asserted-by":"publisher","first-page":"4523","DOI":"10.1038\/s41598-020-61472-7","volume":"10","author":"RCXZ Wang","year":"2020","unstructured":"Wang RCXZ. Prevalence of atrophic gastritis in southwest China and predictive strength of serum gastrin-17: a cross-sectional study (SIGES). Sci Rep. 2020;10:4523.","journal-title":"Sci Rep"},{"key":"7959_CR21","doi-asserted-by":"publisher","first-page":"300060520914826","DOI":"10.1177\/0300060520914826","volume":"48","author":"Y Wang","year":"2020","unstructured":"Wang Y, Zhu Z, Liu Z, Zhao Z, Xue X, Li X, Li P, Rong GMY. Diagnostic value of serum pepsinogen I, pepsinogen II, and gastrin-17 levels for population-based screening for early-stage gastric cancer. J Int Med Res. 2020;48:300060520914826.","journal-title":"J Int Med Res"},{"key":"7959_CR22","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1038\/sj.bjp.0706053","volume":"144","author":"R Colucci","year":"2005","unstructured":"Colucci R, Blandizzi C, Tanini M, Vassalle C, Breschi MCDTM. Gastrin promotes human colon cancer cell growth via CCK-2 receptor-mediated cyclooxygenase-2 induction and prostaglandin E2 production. Br J Pharmacol. 2005;144:338\u201348.","journal-title":"Br J Pharmacol"},{"key":"7959_CR23","first-page":"2187","volume":"29","author":"CHS Davy","year":"2021","unstructured":"Davy CHS. On the other hand, severe radiation-induced oral mucositis can directly result in decreased appetite, malnourishment, and weight loss. Numerous studies have looked into ways to lessen weight loss and mucositis. Support Care Cancer. 2021;29:2187\u2013202.","journal-title":"Support Care Cancer"},{"key":"7959_CR24","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.oraloncology.2017.06.003","volume":"71","author":"L Arribas","year":"2017","unstructured":"Arribas L, Hurtos L, Taberna M, Peiro I, Vilajosana E, Lozano A, Vazquez S, Mesia RVN. Nutritional changes in patients with locally advanced head and neck cancer during treatment. Oral Oncol. 2017;71:67\u201374.","journal-title":"Oral Oncol"},{"key":"7959_CR25","doi-asserted-by":"crossref","unstructured":"Wu C, Liu Y, Shi F, Chen F, Zhao Y, Zhao H. The relationship of serum gastrin-17 and oral mucositis in head and neck carcinoma patients receiving radiotherapy. Discover Oncology. 2022 Dec 1 [cited 2025 May 25];13(1):1\u20136. Available from: https:\/\/link.springer.com\/article\/10.1007\/s12672-022-00570-6. Cited 2025 May 25.","DOI":"10.1007\/s12672-022-00570-6"},{"issue":"20","key":"7959_CR26","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","volume":"310","author":"WM Association","year":"2013","unstructured":"Association WM. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191\u20134.","journal-title":"JAMA"},{"key":"7959_CR27","doi-asserted-by":"publisher","unstructured":"Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8:18.\u00a0https:\/\/doi.org\/10.1186\/1741-7015-8-18.","DOI":"10.1186\/1741-7015-8-18"},{"key":"7959_CR28","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1186\/s12885-023-10730-8","volume":"23","author":"V Ramezani","year":"2023","unstructured":"Ramezani V, Ghadirian S, Shabani M, et al. Efficacy of curcumin for amelioration of radiotherapy-induced oral mucositis: a preliminary randomized controlled clinical trial. Cancer BMC. 2023;23:354.","journal-title":"Cancer BMC"},{"key":"7959_CR29","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1007\/s00432-020-03347-y","volume":"147","author":"HR Won","year":"2021","unstructured":"Won HR, Lee GH, Kim JH, Lee SH, Kwon SY, Baek SK, et al. Effects of N-acetylcysteine inhalation therapy on the quality of life of patients with head and neck cancer who are receiving radiation therapy: a prospective non-randomized controlled multi-center study. J Cancer Res Clin Oncol. 2021;147:539\u201347.","journal-title":"J Cancer Res Clin Oncol"},{"key":"7959_CR30","doi-asserted-by":"crossref","unstructured":"Bakr IS, Zaki AM, El-Moslemany RM, Elsaka RO. Vitamin D oral gel for prevention of radiation-induced oral mucositis: a randomized clinical trial. Oral Dis. 2021;27(5):1197\u2013204. https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/odi.13650.","DOI":"10.1111\/odi.13650"},{"issue":"1","key":"7959_CR31","doi-asserted-by":"publisher","first-page":"33","DOI":"10.3892\/or.2014.3564","volume":"33","author":"T Tsujimoto","year":"2015","unstructured":"Tsujimoto T, YamamotoY, Wasa M, Takenaka Y, Nakahara Su T, Ta, et al. L-glutamin decreases the severity of mucositis induced by chemoradiotherapy in patients with locally advanced head and neck cancer: adouble-blind,randomized,placebo-controlled trial. Oncol Rep. 2015;33(1):33\u20139.","journal-title":"Oncol Rep"},{"key":"7959_CR32","unstructured":"Rosner B. Hypothesis Testing: Two-Sample Inference. In: Rosner B, editor. In: Fundamentals of biostatistics. 7th ed. Boston: Brooks\/Cole, Nelson Educ; 2015;269\u2013301.\u00a0https:\/\/www.unilus.ac.zm\/lms\/e-books\/books\/Basic_Sciences\/Behavioural%20sciences%20and%20public%20health\/Fundamentals%20of%20Biostatistics%20%287th%20Edition%29.pdf?utm_source=chatgpt.com."},{"key":"7959_CR33","unstructured":"Heinrich Heine Universit\u00e4t D\u00fcsseldorf. G * Power (version3.1)[Internet]. D\u00fcsseldorf: Heinrich Heine University D\u00fcsseldorf; 2019 [cited2026 Feb 23]. Available from: https:\/\/www.gpower.hhu.de\/."},{"issue":"5","key":"7959_CR34","first-page":"345","volume":"53","author":"PJ Karanicolas","year":"2010","unstructured":"Karanicolas PJ, Farrokhyar FBM. Practical tips for surgical research: blinding: who, what, when, why. how? Can J Surg. 2010;53(5):345\u20138.","journal-title":"how? Can J Surg"},{"issue":"2","key":"7959_CR35","doi-asserted-by":"publisher","first-page":"113","DOI":"10.3109\/08037059209077502","volume":"1","author":"L Hansson","year":"1992","unstructured":"Hansson L, Hedner T, Dahl\u00f6f B. Prospective randomized open blinded end-point (PROBE) study. A novel design for intervention trials. Prospective randomized open blinded end-point. Blood Press. 1992;1(2):113\u20139.","journal-title":"Blood Press"},{"key":"7959_CR36","doi-asserted-by":"crossref","unstructured":"McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276\u201382. https:\/\/www.biochemia-medica.com\/en\/journal\/22\/3\/10.11613\/BM.2012.031.","DOI":"10.11613\/BM.2012.031"},{"key":"7959_CR37","unstructured":"Saber A. The study of loading and release of N-acetylcystein by chitosan nanoparticles.\u00a0J Biomed Eng Res. 2020;2(3):14\u201321."},{"key":"7959_CR38","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1016\/j.carbpol.2007.12.006","volume":"73","author":"L Fan","year":"2008","unstructured":"Fan L, Wu H, Zhang H, Li F, Yang T, Gu C, et al. Novel super pH-sensitive nanoparticles responsive to tumor extracellular pH. Carbohyd Polym. 2008;73:390\u2013400.","journal-title":"Carbohyd Polym"},{"issue":"1","key":"7959_CR39","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12903-023-03276-5","volume":"23","author":"BM Morsy","year":"2023","unstructured":"Morsy BM, El Domiaty S, Meheissen MAM, Heikal LA, Meheissen MA, Aly NM. Omega-3 nanoemulgel in prevention of radiation-induced oral mucositis and its associated effect on microbiome: a randomized clinical trial. BMC Oral Health. 2023;23(1):1\u201312.","journal-title":"BMC Oral Health"},{"key":"7959_CR40","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1002\/cncr.28592","volume":"120","author":"RV Lalla","year":"2014","unstructured":"Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, et al. Mucositis guidelines leadership group of the multinational association of supportive care in Cancer and International Society of Oral Oncology (MASCC\/ISOO). MASCC\/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therap. Cancer. 2014;120:1453\u201361.","journal-title":"Cancer"},{"key":"7959_CR41","first-page":"116","volume":"48","author":"World Health Organization WH for reporting results of cancer treatment","year":"1979","unstructured":"World Health Organization WH for reporting results of cancer treatment. G Geneva: World Health Organ. 1979;48:116\u20137.","journal-title":"G Geneva: World Health Organ"},{"key":"7959_CR42","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1111\/j.1600-0528.1997.tb00941.x","volume":"25","author":"Slade","year":"1997","unstructured":"GD, Slade. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol. 1997;25:284\u201390.","journal-title":"Community Dent Oral Epidemiol"},{"issue":"12","key":"7959_CR43","doi-asserted-by":"publisher","first-page":"e23518","DOI":"10.1002\/jcla.23518","volume":"34","author":"YY Wenjun Liu, Youxiang Sun","year":"2020","unstructured":"Wenjun Liu, Youxiang Sun YY. Analysis of serum gastrin-17 and Helicobacter pylori antibody in healthy Chinese population. J Clin Lab Anal. 2020;34(12):e23518.","journal-title":"J Clin Lab Anal"},{"issue":"1","key":"7959_CR44","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1111\/adj.12134","volume":"59","author":"N Beech","year":"2014","unstructured":"Beech N, Robinson S, Porceddu S, Batstone M. Dental management of patients irradiated for head and neck cancer. Aust Dent J. 2014;59(1):20\u20138.","journal-title":"Aust Dent J"},{"issue":"1","key":"7959_CR45","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1186\/s13046-020-01715-7","volume":"39","author":"C Pulito","year":"2020","unstructured":"Pulito C, Cristaudo A, Porta C, Zapperi S, Blandino G, Morrone A, Strano S. Oral mucositis: the hidden side of cancer therapy. J Exp Clin Cancer Res. 2020;39(1):210.","journal-title":"J Exp Clin Cancer Res"},{"issue":"8","key":"7959_CR46","doi-asserted-by":"publisher","first-page":"4117","DOI":"10.1016\/j.bbagen.2013.04.016","volume":"1830","author":"Y Samuni","year":"2013","unstructured":"Samuni Y, Goldstein S, Dean OM, Berk M. The chemistry and biological activities of N-acetylcysteine. Biochim Biophys Acta. 2013;1830(8):4117\u201329. https:\/\/doi.org\/10.1016\/j.bbagen.2013.04.016.","journal-title":"Biochim Biophys Acta"},{"issue":"12","key":"7959_CR47","doi-asserted-by":"publisher","first-page":"370","DOI":"10.3390\/md15120370","volume":"15","author":"MM Silva","year":"2017","unstructured":"Silva MM, Calado R, Marto J, Bettencourt A, Almeida AJ, Gon\u00e7alves LMD. Chitosan nanoparticles as a mucoadhesive drug delivery system for ocular administration. Mar Drugs. 2017;15(12):370. https:\/\/doi.org\/10.3390\/md15120370.","journal-title":"Mar Drugs"},{"issue":"Pt B","key":"7959_CR48","doi-asserted-by":"publisher","first-page":"1610","DOI":"10.1016\/j.ijbiomac.2018.09.185","volume":"120","author":"EMA Hejjaji","year":"2018","unstructured":"Hejjaji EMA, Smith AM, Morris GA. Evaluation of the mucoadhesive properties of chitosan nanoparticles prepared using different chitosan to tripolyphosphate (CS:TPP) ratios. Int J Biol Macromol. 2018;120(Pt B):1610\u20137. https:\/\/doi.org\/10.1016\/j.ijbiomac.2018.09.185.","journal-title":"Int J Biol Macromol"},{"key":"7959_CR49","doi-asserted-by":"crossref","unstructured":"Moslehi A, Taghizadeh-Ghehi M, Gholami K, Hadjibabaie M, Jahangard-Rafsanjani Z, Sarayani A et al. N-acetyl cysteine for prevention of oral mucositis in hematopoietic SCT: a double-blind, randomized, placebo-controlled trial. Bone Marrow Transplant. 2014;49(6):818\u2009\u2013\u200923. doi: 10.1038\/bmt.2014.34. Epub 2014 Mar 10. PMID: 24614837.","DOI":"10.1038\/bmt.2014.34"},{"issue":"7","key":"7959_CR50","doi-asserted-by":"publisher","first-page":"1851","DOI":"10.31557\/APJCP.2020.21.7.1851","volume":"21","author":"G Sant Ana","year":"2020","unstructured":"Sant Ana G, Normando AGC, De Toledo I, Dos Reis PED, Guerra ENS. Topical treatment of oral mucositis in cancer patients: a systematic review of randomized clinical trials. Asian Pac J Cancer Prev. 2020;21(7):1851\u201366. PMID: 32711408; PMCID: PMC7573410.","journal-title":"Asian Pac J Cancer Prev"},{"key":"7959_CR51","doi-asserted-by":"publisher","unstructured":"Barkokebas A, Silva IHM, de Andrade SC, Carvalho AAT, Gueiros LAM, Paiva SM et al. Impact of oral mucositis on oral-health-related quality of life of patients diagnosed with cancer. Journal of Oral Pathology and Medicine. 2015 Oct 1;44(9):746\u201351. Available from: https:\/\/doi.org\/10.1111\/jop.12282. Cited 2025 May 18.","DOI":"10.1111\/jop.12282"},{"key":"7959_CR52","doi-asserted-by":"crossref","unstructured":"Jung YS, Park EY, Sohn HO. Oral health status and oral health-related quality of life according to presence or absence of mucositis in head and neck cancer patients. J Cancer Prev. 2019 Mar 30;24(1):43. Available from: https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC6453589\/. Cited 2025 May 18.","DOI":"10.15430\/JCP.2019.24.1.43"},{"key":"7959_CR53","doi-asserted-by":"crossref","unstructured":"Husain FA, Tatengkeng F. Oral health-related quality of life appraised by OHIP-14 between urban and rural areas in Kutai Kartanegara Regency, Indonesia: pilot pathfinder survey. Open Dent J. 2017 Nov 7;11(1):557. Available from: https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5712656\/. Cited 2025 Jun 3.","DOI":"10.2174\/1874210601711010557"},{"issue":"4","key":"7959_CR54","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.4143\/crt.2020.012","volume":"52","author":"HJ Kim","year":"2020","unstructured":"Kim HJ, Kang SU, Lee YS, Jang JY, Kang H, Kim CH. Protective Effects of N-Acetylcysteine against radiation-induced oral mucositis in vitro and in vivo. Cancer Res Treat. 2020;52(4):1019\u201330. https:\/\/doi.org\/10.4143\/crt.2020.012. Epub 2020 Jun 18. PMID: 32599978; PMCID: PMC7577823.","journal-title":"Cancer Res Treat"},{"key":"7959_CR55","doi-asserted-by":"crossref","unstructured":"Lalla RV, Peterson DE. Oral Mucositis. Dent Clin North Am. 2023 May 29 [cited 2025 Jun 3];49(1 SPEC.ISS.):167\u201384. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK565848\/. Cited 2025 Jun 3.","DOI":"10.1016\/j.cden.2004.07.009"},{"key":"7959_CR56","doi-asserted-by":"crossref","unstructured":"de Lessa FN, Meirelles A, Do Couto DP, Duarte Da Silva AM, De Aguiar K. MCF. Scales to graduate oral mucositis: what are the limitations? Oral Oncol. 2023 Sep 1;144:106489. Available from: https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S1368837523001859. Cited 2025 Jun 3.","DOI":"10.1016\/j.oraloncology.2023.106489"},{"key":"7959_CR57","doi-asserted-by":"crossref","unstructured":"Kamide D, Yamashita T, Araki K, Tomifuji M, Shiotani A. Hangeshashinto (TJ-14) prevents radiation-induced mucositis by suppressing cyclooxygenase-2 expression and chemotaxis of inflammatory cells. Clinical and Translational Oncology. 2017 Nov 1;19(11):1329\u201336. Available from: https:\/\/link.springer.com\/article\/10.1007\/s12094-017-1672-8. Cited 2025 Jun 3.","DOI":"10.1007\/s12094-017-1672-8"},{"key":"7959_CR58","doi-asserted-by":"crossref","unstructured":"Takeuchi K, Amagase K. Roles of cyclooxygenase, prostaglandin E2 and EP receptors in mucosal protection and ulcer healing in the gastrointestinal tract. Curr Pharm Des. 2018 Jun 29;24(18):2002\u201311. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/29956615\/. Cited 2025 May 19.","DOI":"10.2174\/1381612824666180629111227"}],"container-title":["BMC Oral Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12903-026-07959-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-026-07959-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-026-07959-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T07:54:08Z","timestamp":1775721248000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12903-026-07959-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":58,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["7959"],"URL":"https:\/\/doi.org\/10.1186\/s12903-026-07959-7","relation":{},"ISSN":["1472-6831"],"issn-type":[{"value":"1472-6831","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,20]]},"assertion":[{"value":"5 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"A clinical trial was conducted following Helsinki's code and CONSORT guidelines. The study was a randomized, parallel, single-blind clinical trial, applying CONSORT specifications, with participants randomly assigned into test and control groups using a computer-generated random list. Ethical approval for the study was obtained from the Research Ethics Committee at the Faculty of Dentistry, Alexandria University (IRB 00010556) - (IORG 0008839). Detailed informed consent was provided by each patient.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"616"}}